Wednesday, August 9, 2017

-A To Do List for the New Registrar--Dr. Scott McLeod of the College of Physicians and Surgeons of Alberta--------------Q: But isn’t the health system evolving to focus more on team-based care? Can doctors serve as leaders the same way they used to do? A: You don’t have to be the boss to be a leader. Leadership is about influencing teams to improve outcomes. That said, there will be times where a physician may be the appropriate person to be the leader and be in charge of that team. If they are going to be in charge, we have to teach them how to be good leaders.

Leadership can't happen without patient rights in the medical system and resident rights in the continuing care system. What kind of leadership will y'all have without inclusion of the ones the team is working on?

New registrar wants Alberta physicians to embrace larger leadership role

The new leader of the College of Physicians and Surgeons of Alberta is a career military man, a highly trained professional accustomed to orderly environments and a chain of command.

But for provincial doctors who may be wondering if Dr. Scott McLeod plans to wield military discipline in his new civilian job, the Regina native says such hard-line tactics are generally the worst way to influence behaviour.

“I’m certainly a planner and an organizer and I like to see things move forward for a purpose,” he said Tuesday. “But I’ve also found engagement and working with people typically is going to be the best way to move the vast majority of people forward.”

McLeod said he learned that lesson as part of the training he received in leadership, a skill he would like to see more Alberta doctors embrace in the years ahead. The success of an evolving health system depends on having physicians engaged in improving it, he said.

“Historically, physicians have not looked upon leadership roles as very good or very important. We have seen it as going to the dark side. We need to change that.”

Q: Why did you decide to leave the military and accept the job as registrar?

A: When you start getting into 25-plus years in the military, you start looking at other options to see what may be out there. The past few years I have been working on clinical governance and leadership in health care and I thought this may be an opportunity to be able to transition that into the civilian health-care system.

Q: But isn’t the health system evolving to focus more on team-based care? Can doctors serve as leaders the same way they used to do?

A: You don’t have to be the boss to be a leader. Leadership is about influencing teams to improve outcomes. That said, there will be times where a physician may be the appropriate person to be the leader and be in charge of that team. If they are going to be in charge, we have to teach them how to be good leaders.

Q: College leaders have faced controversy in recent years for taking stands on health policy issues, such as recruitment of foreign doctors. Critics believe they shouldn’t be “advocates” and instead stick to a narrow role of licensing and discipline. Where do you stand?

A: Our role is about enhancing public safety and we are supposed to be able to guide the medical profession to be able to enhance the care that’s being provided. So there are going to be times where the college should have a voice on some of those things.

Q: One of your past roles was focused on mental health in the military. What lessons did you learn in that job you can bring to Alberta’s stressed physician community?

A: A lot of the mental illness that occurs in the Canadian Forces has nothing to do with deployed operations. It’s the normal stressors that occur day to day, as we try to get people to do more and more with less and less.

Our program in the military called the Road to Mental Readiness is about … giving people skills to build some resiliency to handle stressors of life early in their careers.

Recognizing that you are part of a team can help, that you don’t have to wear all the weight yourself. And recognizing that you have to look after your own health before you can look after anybody else’s.

The military has done an incredible job of reducing that stigma where people are much more accepting of someone going in and getting help for mental illness. But they are still resistant to go themselves. That’s the self-stigma part of it. I think the physician community is very similar.

Q: What is your impression of the Alberta health system so far?

A: One of the things that drew me here is I believe the Alberta health-care system does have an opportunity to really be the best health-care system. I think having one health system (Alberta Health Services) does make it easier than having a variety of regions. I think there is some good leadership in Alberta right now to have some positive change that is focused on quality health care. There is lots of evidence you can control costs by focusing on quality.

Q: The college has had a role in addressing the opioid crisis by introducing new professional rules to get doctors to adopt more caution in their prescribing habits for pain. Is there anything else the college can do?

A: The college is engaged at the national level and provincial level, working with other providers to make sure we are not just dealing with it as an opioid crisis. It’s about how we improve the treatment of chronic pain, making sure we are looking after the patients in the best way possible, and not just laying down the law on the prescribing of opioids.

We know there are some practice behaviours that are dangerous and we want to track that and we want to help physicians look after their patients in probably a much more robust way than just using the opioids for pain control.

McLeod’s long career with the Canadian Forces included stints as the flight surgeon for the Snowbirds in Moose Jaw and surgeon for the Canadian Air Division in Winnipeg, followed by postings in Ottawa as the director of mental health and the deputy surgeon general. He also spent four years at a NATO base in Germany and deployed to Afghanistan in 2008 as commander of the Role 3 multinational hospital in Kandahar.

His arrival in Alberta comes at a time when the college is wresting with a number of complex issues, including the opioid crisis, escalating physician costs, and a desire by the province to better control the number of new doctors entering the workforce.

While the new registrar is looking at how to develop leadership in Alberta doctors there are other areas he needs to work on:

1) Ethical decision makingWhen there is a personal directive asking for full resuscitation and doctors unilaterally decide on a "Do Not Resuscitate" order there needs to be ethical training of doctors so that they appropriately respond to patients and families rather than considering costs to the medical system.

2) The rights of patientsThere are no patient rights in the medical system and no resident rights in the continuing care system. The health care system and the continuing care system can and does engage in human rights abuses by imposing banning restrictions on vulnerable citizens. As a medical leader the registrar needs to look at the issue of banning, the rights of patients/ residents to have visitation and advocacy and work to engage doctors in providing the most appropriate solutions to conflict solutions. Resolution and not retribution should be the key. I am appalled that doctors have not taken a stand against this abuse of power by the GOA and the heatlh authority as well as the continuing care system. Silence is indeed complicit.

3) Foreign medical doctors.I note that the College permits speedy inclusion of doctors from South Africa. Why not doctors from other countries? There should be seamless integration of all medical professionals. It is a waste of trained resources to have them waiting for a residency opportunity when they are fully trained and ready to go.I would almost think there is a bias against foreign doctors except those from South Africa by the College because I have seen many South African doctors arrive and get jobs while other doctors from other countries are limited in opportunities. The College needs to take on an advocacy role for these unfortunate doctors who are doing work as clerks and taxi drivers rather than being employed in medicine.

4) Complaints by patientsThe registrar needs to improve the complaint process. As it is patients who complain are apt to lose any chance of getting another doctor. This sort of black listing by doctors needs to end. Also the discharge of patients when the patient asks for a second opinion should be disallowed. It's ridiculous that patients feel that they cannot get a second opinion because it might hurt the feelings of their doctor who would then dump them. This is a practice that needs to end.

Leadership is more than the medical degree. It is being respectful and ethical. It is understanding the power of the position and not abusing it. It is being aware that you are not the only one with the knowledge and that a second opinion may be useful and is not disrespectful but the right of the patient. Complaints need to be handled better by the College so that patients don't feel afraid to make them.

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